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1. In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas

Author

Janko, Matthew R., Woo, Karen, Hacker, Robert I., Baril, Donald, Bath, Jonathan, Smeds, Matthew R., Kashyap, Vikram S., Szeberin, Zoltan, Magee, Gregory A., Elsayed, Ramsey, Wishy, Andrew, St. John, Rebecca, Beck, Adam, Farber, Mark, Motta, Fernando, Zhou, Wei, Lemmon, Gary, Coleman, Dawn, Behrendt, Christian-Alexander, Aziz, Faisal, Black, James, Shutze, William, Garrett, H. Edward, Jr., De Caridi, Giovanni, Liapis, Christos D., Geroulakos, George, Kakisis, John, Moulakakis, Konstantinos, Kakkos, Stavros K., Obara, Hideaki, Wang, Grace, Rhéaume, Pascal, Davila, Victor, Ravin, Reid, DeMartino, Randall, Milner, Ross, Shalhub, Sherene, Jim, Jeffrey, Lee, Jason, Dubuis, Celine, Ricco, Jean-Baptiste, Coselli, Joseph, Lemaire, Scott, Fatima, Javairiah, Sanford, Jennifer, Yoshida, Winston, Schermerhorn, Marc L., Menard, Matthew, Belkin, Michael, Blackwood, Stuart, Conrad, Mark, Wang, Linda, Crofts, Sara, Nixon, Thomas, Wu, Timothy, Chiesa, Roberto, Bose, Saideep, Turner, Jason, Moore, Ryan, Smith, Justin, Ciocca, Rocco, Hsu, Jeffrey, Czerny, Martin, Cullen, Jonathan, Kahlberg, Andrea, Setacci, Carlo, Joh, Jin Hyun, Senneville, Eric, Garrido, Pedro, Sarac, Timur P., Rizzo, Anthony, Go, Michael R., Bjorck, Martin, Gavali, Hamid, Wanhainen, Anders, Lawrence, Peter F., and Chung, Jayer

Published
2021
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2. An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis

Author

Zorgeenheid Vaatchirurgie Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Paraskevas, Kosmas I., Mikhailidis, Dimitri P., Ringleb, Peter Arthur, Brown, Martin M., Dardik, Alan, Poredos, Pavel, Gray, William A., Nicolaides, Andrew N., Lal, Brajesh K., Mansilha, Armando, Antignani, Pier Luigi, de Borst, Gert J., Cambria, Richard P., Loftus, Ian M., Lavie, Carl J., Blinc, Ales, Lyden, Sean P., Matsumura, Jon S., Jezovnik, Mateja K., Bacharach, J. Michael, Meschia, James F., Clair, Daniel G., Zeebregts, Clark J., Lanza, Gaetano, Capoccia, Laura, Spinelli, Francesco, Liapis, Christos D., Jawien, Arkadiusz, Parikh, Sahil A., Svetlikov, Alexei, Menyhei, Gabor, Davies, Alun H., Musialek, Piotr, Roubin, Gary, Stilo, Francesco, Sultan, Sherif, Proczka, Robert M., Faggioli, Gianluca, Geroulakos, George, Fernandes e Fernandes, Jose, Ricco, Jean Baptiste, Saba, Luca, Secemsky, Eric A., Pini, Rodolfo, Myrcha, Piotr, Rundek, Tatjana, Martinelli, Ombretta, Kakkos, Stavros K., Sachar, Ravish, Goudot, Guillaume, Schlachetzki, Felix, Lavenson, George S., Ricci, Stefano, Topakian, Raffi, Millon, Antoine, Di Lazzaro, Vincenzo, Silvestrini, Mauro, Chaturvedi, Seemant, Eckstein, Hans Henning, Gloviczki, Peter, White, Christopher J., Zorgeenheid Vaatchirurgie Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Paraskevas, Kosmas I., Mikhailidis, Dimitri P., Ringleb, Peter Arthur, Brown, Martin M., Dardik, Alan, Poredos, Pavel, Gray, William A., Nicolaides, Andrew N., Lal, Brajesh K., Mansilha, Armando, Antignani, Pier Luigi, de Borst, Gert J., Cambria, Richard P., Loftus, Ian M., Lavie, Carl J., Blinc, Ales, Lyden, Sean P., Matsumura, Jon S., Jezovnik, Mateja K., Bacharach, J. Michael, Meschia, James F., Clair, Daniel G., Zeebregts, Clark J., Lanza, Gaetano, Capoccia, Laura, Spinelli, Francesco, Liapis, Christos D., Jawien, Arkadiusz, Parikh, Sahil A., Svetlikov, Alexei, Menyhei, Gabor, Davies, Alun H., Musialek, Piotr, Roubin, Gary, Stilo, Francesco, Sultan, Sherif, Proczka, Robert M., Faggioli, Gianluca, Geroulakos, George, Fernandes e Fernandes, Jose, Ricco, Jean Baptiste, Saba, Luca, Secemsky, Eric A., Pini, Rodolfo, Myrcha, Piotr, Rundek, Tatjana, Martinelli, Ombretta, Kakkos, Stavros K., Sachar, Ravish, Goudot, Guillaume, Schlachetzki, Felix, Lavenson, George S., Ricci, Stefano, Topakian, Raffi, Millon, Antoine, Di Lazzaro, Vincenzo, Silvestrini, Mauro, Chaturvedi, Seemant, Eckstein, Hans Henning, Gloviczki, Peter, and White, Christopher J.

Published
2024

3. An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis

Author

Paraskevas, Kosmas I., primary, Mikhailidis, Dimitri P., additional, Ringleb, Peter Arthur, additional, Brown, Martin M., additional, Dardik, Alan, additional, Poredos, Pavel, additional, Gray, William A., additional, Nicolaides, Andrew N., additional, Lal, Brajesh K., additional, Mansilha, Armando, additional, Antignani, Pier Luigi, additional, de Borst, Gert J., additional, Cambria, Richard P., additional, Loftus, Ian M., additional, Lavie, Carl J., additional, Blinc, Ales, additional, Lyden, Sean P., additional, Matsumura, Jon S., additional, Jezovnik, Mateja K., additional, Bacharach, J. Michael, additional, Meschia, James F., additional, Clair, Daniel G., additional, Zeebregts, Clark J., additional, Lanza, Gaetano, additional, Capoccia, Laura, additional, Spinelli, Francesco, additional, Liapis, Christos D., additional, Jawien, Arkadiusz, additional, Parikh, Sahil A., additional, Svetlikov, Alexei, additional, Menyhei, Gabor, additional, Davies, Alun H., additional, Musialek, Piotr, additional, Roubin, Gary, additional, Stilo, Francesco, additional, Sultan, Sherif, additional, Proczka, Robert M., additional, Faggioli, Gianluca, additional, Geroulakos, George, additional, Fernandes e Fernandes, Jose, additional, Ricco, Jean-Baptiste, additional, Saba, Luca, additional, Secemsky, Eric A., additional, Pini, Rodolfo, additional, Myrcha, Piotr, additional, Rundek, Tatjana, additional, Martinelli, Ombretta, additional, Kakkos, Stavros K., additional, Sachar, Ravish, additional, Goudot, Guillaume, additional, Schlachetzki, Felix, additional, Lavenson, George S., additional, Ricci, Stefano, additional, Topakian, Raffi, additional, Millon, Antoine, additional, Di Lazzaro, Vincenzo, additional, Silvestrini, Mauro, additional, Chaturvedi, Seemant, additional, Eckstein, Hans-Henning, additional, Gloviczki, Peter, additional, and White, Christopher J., additional

Published
2023
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4. Recent advances and controversial issues in the optimal management of asymptomatic carotid stenosis

Author

Paraskevas, Kosmas I., primary, Brown, Martin M., additional, Lal, Brajesh K., additional, Myrcha, Piotr, additional, Lyden, Sean P., additional, Schneider, Peter A., additional, Poredos, Pavel, additional, Mikhailidis, Dimitri P., additional, Secemsky, Eric A., additional, Musialek, Piotr, additional, Mansilha, Armando, additional, Parikh, Sahil A., additional, Silvestrini, Mauro, additional, Lavie, Carl J., additional, Dardik, Alan, additional, Blecha, Matthew, additional, Liapis, Christos D., additional, Zeebregts, Clark J., additional, Nederkoorn, Paul J., additional, Poredos, Peter, additional, Gurevich, Victor, additional, Jawien, Arkadiusz, additional, Lanza, Gaetano, additional, Gray, William A., additional, Gupta, Ajay, additional, Svetlikov, Alexei V., additional, Fernandes e Fernandes, Jose, additional, Nicolaides, Andrew N., additional, White, Christopher J., additional, Meschia, James F., additional, Cronenwett, Jack L., additional, Schermerhorn, Marc L., additional, and AbuRahma, Ali F., additional

Published
2023
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8. In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

Author

Janko, Matthew R., primary, Hubbard, Grant, additional, Back, Martin, additional, Shah, Samir K., additional, Pomozi, Eniko, additional, Szeberin, Zoltan, additional, DeMartino, Randall, additional, Wang, Linda J., additional, Crofts, Sarah, additional, Belkin, Michael, additional, Davila, Victor J., additional, Lemmon, Gary W., additional, Wang, Shihuan K., additional, Czerny, Martin, additional, Kreibich, Maximilian, additional, Humphries, Misty D., additional, Shutze, William, additional, Joh, Jin Hyun, additional, Cho, Sungsin, additional, Behrendt, Christian-Alexander, additional, Setacci, Carlo, additional, Hacker, Robert I., additional, Sobreira, Marcone Lima, additional, Yoshida, Winston Bonetti, additional, D’Oria, Mario, additional, Lepidi, Sandro, additional, Chiesa, Roberto, additional, Kahlberg, Andrea, additional, Go, Michael R., additional, Rizzo, Anthony N., additional, Black, James H., additional, Magee, Gregory A., additional, Elsayed, Ramsey, additional, Baril, Donald T., additional, Beck, Adam W., additional, McFarland, Graeme E., additional, Gavali, Hamid, additional, Wanhainen, Anders, additional, Kashyap, Vikram S., additional, Stoecker, Jordan B., additional, Wang, Grace J., additional, Zhou, Wei, additional, Fujimura, Naoki, additional, Obara, Hideaki, additional, Wishy, Andrew M., additional, Bose, Saideep, additional, Smeds, Matthew, additional, Liang, Patric, additional, Schermerhorn, Marc, additional, Conrad, Mark F., additional, Hsu, Jeffrey H., additional, Patel, Rhusheet, additional, Lee, Jason T., additional, Liapis, Christos D., additional, Moulakakis, Konstantinos G., additional, Farber, Mark A., additional, Motta, Fernando, additional, Ricco, Jean-Baptiste, additional, Bath, Jonathan, additional, Coselli, Joseph S., additional, Aziz, Faisal, additional, Coleman, Dawn M., additional, Davis, Frank M., additional, Fatima, Javairiah, additional, Irshad, Ali, additional, Shalhub, Sherene, additional, Kakkos, Stavros, additional, Zhang, Qianzi, additional, Lawrence, Peter F., additional, Woo, Karen, additional, and Chung, Jayer, additional

Published
2022
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11. In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

Author

Janko, Matthew R., Hubbard, Grant, Back, Martin, Shah, Samir K., Pomozi, Eniko, Szeberin, Zoltan, DeMartino, Randall, Wang, Linda J., Crofts, Sarah, Belkin, Michael, Davila, Victor J., Lemmon, Gary W., Wang, Shihuan K., Czerny, Martin, Kreibich, Maximilian, Humphries, Misty D., Shutze, William, Joh, Jin Hyun, Cho, Sungsin, Behrendt, Christian-Alexander, Setacci, Carlo, Hacker, Robert, I, Sobreira, Marcone Lima, Yoshida, Winston Bonetti, D'Oria, Mario, Lepidi, Sandro, Chiesa, Roberto, Kahlberg, Andrea, Go, Michael R., Rizzo, Anthony N., Black, James H., Magee, Gregory A., Elsayed, Ramsey, Baril, Donald T., Beck, Adam W., McFarland, Graeme E., Gavali, Hamid, Wanhainen, Anders, Kashyap, Vikram S., Stoecker, Jordan B., Wang, Grace J., Zhou, Wei, Fujimura, Naoki, Obara, Hideaki, Wishy, Andrew M., Bose, Saideep, Smeds, Matthew, Liang, Patric, Schermerhorn, Marc, Conrad, Mark F., Hsu, Jeffrey H., Patel, Rhusheet, Lee, Jason T., Liapis, Christos D., Moulakakis, Konstantinos G., Farber, Mark A., Motta, Fernando, Ricco, Jean-Baptiste, Bath, Jonathan, Coselli, Joseph S., Aziz, Faisal, Coleman, Dawn M., Davis, Frank M., Fatima, Javairiah, Irshad, Ali, Shalhub, Sherene, Kakkos, Stavros, Zhang, Qianzi, Lawrence, Peter F., Woo, Karen, Chung, Jayer, Janko, Matthew R., Hubbard, Grant, Back, Martin, Shah, Samir K., Pomozi, Eniko, Szeberin, Zoltan, DeMartino, Randall, Wang, Linda J., Crofts, Sarah, Belkin, Michael, Davila, Victor J., Lemmon, Gary W., Wang, Shihuan K., Czerny, Martin, Kreibich, Maximilian, Humphries, Misty D., Shutze, William, Joh, Jin Hyun, Cho, Sungsin, Behrendt, Christian-Alexander, Setacci, Carlo, Hacker, Robert, I, Sobreira, Marcone Lima, Yoshida, Winston Bonetti, D'Oria, Mario, Lepidi, Sandro, Chiesa, Roberto, Kahlberg, Andrea, Go, Michael R., Rizzo, Anthony N., Black, James H., Magee, Gregory A., Elsayed, Ramsey, Baril, Donald T., Beck, Adam W., McFarland, Graeme E., Gavali, Hamid, Wanhainen, Anders, Kashyap, Vikram S., Stoecker, Jordan B., Wang, Grace J., Zhou, Wei, Fujimura, Naoki, Obara, Hideaki, Wishy, Andrew M., Bose, Saideep, Smeds, Matthew, Liang, Patric, Schermerhorn, Marc, Conrad, Mark F., Hsu, Jeffrey H., Patel, Rhusheet, Lee, Jason T., Liapis, Christos D., Moulakakis, Konstantinos G., Farber, Mark A., Motta, Fernando, Ricco, Jean-Baptiste, Bath, Jonathan, Coselli, Joseph S., Aziz, Faisal, Coleman, Dawn M., Davis, Frank M., Fatima, Javairiah, Irshad, Ali, Shalhub, Sherene, Kakkos, Stavros, Zhang, Qianzi, Lawrence, Peter F., Woo, Karen, and Chung, Jayer

Abstract

Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P <.001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P <.001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001)

Published
2022
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15. Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

Author

Paraskevas, Kosmas I. Mikhailidis, Dimitri P. Antignani, Pier Luigi Baradaran, Hediyeh Bokkers, Reinoud P. Cambria, Richard P. Dardik, Alan Davies, Alun H. Eckstein, Hans-Henning Faggioli, Gianluca Fernandes E Fernandes, Jose Fraedrich, Gustav Geroulakos, George Gloviczki, Peter Golledge, Jonathan Gupta, Ajay Jezovnik, Mateja K. Kakkos, Stavros K. Katsiki, Niki Knoflach, Michael Kooi, M. Eline Lanza, Gaetano Liapis, Christos D. Loftus, Ian M. Mansilha, Armando Millon, Antoine Nicolaides, Andrew N. Pini, Rodolfo Poredos, Pavel Ricco, Jean-Baptiste Riles, Thomas S. Ringleb, Peter Arthur Rundek, Tatjana Saba, Luca Schlachetzki, Felix Silvestrini, Mauro Spinelli, Francesco Stilo, Francesco Sultan, Sherif Suri, Jasjit S. Zeebregts, Clark J. Chaturvedi, Seemant

Abstract

Objectives: The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement is to reconcile the conflicting views on the topic. Materials and methods: A literature review was performed with a focus on data from recent studies. Results: Several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with ACS. Such high-risk clinical/imaging features include intraplaque hemorrhage, impaired cerebrovascular reserve, carotid plaque echolucency/ulceration/ neovascularization, a lipid-rich necrotic core, a thin or ruptured fibrous cap, silent brain infarction, a contralateral transient ischemic attack/stroke episode, male patients < 75 years and microembolic signals on transcranial Doppler. There is growing evidence that 80-99% ACS indicate a higher stroke risk than 50-79% stenoses. Conclusions: Although aggressive risk factor control and BMT should be implemented in all ACS patients, several high-risk features that may increase the risk of a future cerebrovascular event are now documented. Consequently, some guidelines recommend a prophylactic carotid intervention in high-risk patients to prevent future cerebrovascular events. Until the results of the much-anticipated randomized controlled trials emerge, the jury is still out regarding the optimal management of ACS patients. (c) 2021 Elsevier Inc. All rights reserved.

Published
2022

18. The burden of carotid-related strokes

Author

Paraskevas, Kosmas I., primary, Mikhailidis, Dimitri P., additional, Baradaran, Hediyeh, additional, Bokkers, Reinoud P. H., additional, Davies, Alun H., additional, Eckstein, Hans-Henning, additional, Faggioli, Gianluca, additional, Fernandes, Jose Fernandes E, additional, Gargiulo, Mauro, additional, Jawien, Arkadiusz, additional, Jezovnik, Mateja K., additional, Kakkos, Stavros K., additional, Knoflach, Michael, additional, Kooi, M. Eline, additional, Lanza, Gaetano, additional, Liapis, Christos D., additional, Loftus, Ian M., additional, Mansilha, Armando, additional, Mechtouff, Laura, additional, Millon, Antoine, additional, Myrcha, Piotr, additional, Nicolaides, Andrew N., additional, Pini, Rodolfo, additional, Poredos, Pavel, additional, Ricco, Jean-Baptiste, additional, Rundek, Tatjana, additional, Saba, Luca, additional, Silvestrini, Mauro, additional, Spinelli, Francesco, additional, Stilo, Francesco, additional, Sultan, Sherif, additional, Suri, Jasjit S., additional, Svetlikov, Alexei V., additional, Wijeratne, Tissa, additional, Zeebregts, Clark J., additional, and Gloviczki, Peter, additional

Published
2022
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19. Optimal Management of Asymptomatic Carotid Stenosis: Counterbalancing the Benefits with the Potential Risks

Author

Paraskevas, Kosmas I., primary, Mikhailidis, Dimitri P., additional, Baradaran, Hediyeh, additional, Davies, Alun H., additional, Eckstein, Hans-Henning, additional, Faggioli, Gianluca, additional, Fernandes, Jose Fernandes e, additional, Gupta, Ajay, additional, Jezovnik, Mateja K., additional, Kakkos, Stavros K., additional, Katsiki, Niki, additional, Kooi, M. Eline, additional, Lanza, Gaetano, additional, Liapis, Christos D., additional, Loftus, Ian M., additional, Millon, Antoine, additional, Nicolaides, Andrew N., additional, Poredos, Pavel, additional, Pini, Rodolfo, additional, Ricco, Jean-Baptiste, additional, Rundek, Tatjana, additional, Saba, Luca, additional, Spinelli, Francesco, additional, Stilo, Francesco, additional, Sultan, Sherif, additional, Zeebregts, Clark J., additional, and Chaturvedi, Seemant, additional

Published
2022
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21. Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Author

Janko, Matthew Hubbard, Grant Woo, Karen Kashyap, Vikram S. and Mitchell, Megan Murugesan, Arun Chen, Lin Gardner, Rachel Baril, Donald Hacker, Robert I. Szeberin, Zoltan and ElSayed, Ramsey Magee, Gregory A. Motta, Fernando Zhou, Wei and Lemmon, Gary Coleman, Dawn Behrendt, Christian-Alexander and Aziz, Faisal Black, James H. Tran, Kimberly Dao, Allen and Shutze, William Garrett, H. Edward De Caridi, Giovanni and Patel, Rhusheet Liapis, Christos D. Geroulakos, George and Kakisis, John Moulakakis, Konstantinos Kakkos, Starvos K. and Obara, Hideaki Wang, Grace Stoecker, Jordan Rheaume, Pascal and Davila, Victor Ravin, Reid DeMartino, Randall Milner, Ross Shalhub, Sherene Jim, Jeffrey Lee, Jason Dubuis, Celine Ricco, Jean-Baptiste Coselli, Joseph Lemaire, Scott and Fatima, Javairiah Sanford, Jennifer Yoshida, Winston and Schermerhorn, Marc L. Menard, Matthew Belkin, Michael and Blackwood, Stuart Conrad, Mark Wang, Linda Crofts, Sara and Nixon, Thomas Wu, Timothy Chiesa, Roberto Bose, Saideep and Turner, Jason Moore, Ryan Smith, Justin Irshad, Ali Hsu, Jeffrey Czerny, Martin Cullen, Jonathan Kahlberg, Andrea and Setacci, Carlo Joh, Jin Hyun Senneville, Eric Garrido, Pedro and Sarac, Timur P. Rizzo, Anthony Go, Michael R. Bjorck, Martin Gavali, Hamid Wanhainen, Anders D'Oria, Mario and Lepidi, Sandro Mastrorilli, Davide Veraldi, Gianfranco and Piazza, Michele Squizzato, Francesco Beck, Adam St John, Rebecca Wishy, Andrew Humphries, Misty Shah, Samir K. and Back, Martin Chung, Jayer Lawrence, Peter F. Bath, Jonathan and Smeds, Matthew R.

Abstract

Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs . 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs . 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.

Published
2021

22. Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Author

Janko, Matthew, Hubbard, Grant, Woo, Karen, Kashyap, Vikram S, Mitchell, Megan, Murugesan, Arun, Chen, Lin, Gardner, Rachel, Baril, Donald, Hacker, Robert I, Szeberin, Zoltan, ElSayed, Ramsey, Magee, Gregory A, Motta, Fernando, Zhou, Wei, Lemmon, Gary, Coleman, Dawn, Behrendt, Christian-Alexander, Aziz, Faisal, Black, James H, Tran, Kimberly, Dao, Allen, Shutze, William, Garrett, H Edward, De Caridi, Giovanni, Patel, Rhusheet, Liapis, Christos D, Geroulakos, George, Kakisis, John, Moulakakis, Konstantinos, Kakkos, Starvos K, Obara, Hideaki, Wang, Grace, Stoecker, Jordan, Rhéaume, Pascal, Davila, Victor, Ravin, Reid, DeMartino, Randall, Milner, Ross, Shalhub, Sherene, Jim, Jeffrey, Lee, Jason, Dubuis, Celine, Ricco, Jean-Baptiste, Coselli, Joseph, Lemaire, Scott, Fatima, Javairiah, Sanford, Jennifer, Yoshida, Winston, Schermerhorn, Marc L, Menard, Matthew, Belkin, Michael, Blackwood, Stuart, Conrad, Mark, Wang, Linda, Crofts, Sara, Nixon, Thomas, Wu, Timothy, Chiesa, Roberto, Bose, Saideep, Turner, Jason, Moore, Ryan, Smith, Justin, Irshad, Ali, Hsu, Jeffrey, Czerny, Martin, Cullen, Jonathan, Kahlberg, Andrea, Setacci, Carlo, Joh, Jin Hyun, Senneville, Eric, Garrido, Pedro, Sarac, Timur P, Rizzo, Anthony, Go, Michael R, Björck, Martin, Gavali, Hamid, Wanhainen, Anders, D'Oria, Mario, Lepidi, Sandro, Mastrorilli, Davide, Veraldi, Gianfranco, Piazza, Michele, Squizzato, Francesco, Beck, Adam, St John, Rebecca, Wishy, Andrew, Humphries, Misty, Shah, Samir K, Back, Martin, Chung, Jayer, Lawrence, Peter F, Bath, Jonathan, Smeds, Matthew R, Janko, Matthew, Hubbard, Grant, Woo, Karen, Kashyap, Vikram S, Mitchell, Megan, Murugesan, Arun, Chen, Lin, Gardner, Rachel, Baril, Donald, Hacker, Robert I, Szeberin, Zoltan, ElSayed, Ramsey, Magee, Gregory A, Motta, Fernando, Zhou, Wei, Lemmon, Gary, Coleman, Dawn, Behrendt, Christian-Alexander, Aziz, Faisal, Black, James H, Tran, Kimberly, Dao, Allen, Shutze, William, Garrett, H Edward, De Caridi, Giovanni, Patel, Rhusheet, Liapis, Christos D, Geroulakos, George, Kakisis, John, Moulakakis, Konstantinos, Kakkos, Starvos K, Obara, Hideaki, Wang, Grace, Stoecker, Jordan, Rhéaume, Pascal, Davila, Victor, Ravin, Reid, DeMartino, Randall, Milner, Ross, Shalhub, Sherene, Jim, Jeffrey, Lee, Jason, Dubuis, Celine, Ricco, Jean-Baptiste, Coselli, Joseph, Lemaire, Scott, Fatima, Javairiah, Sanford, Jennifer, Yoshida, Winston, Schermerhorn, Marc L, Menard, Matthew, Belkin, Michael, Blackwood, Stuart, Conrad, Mark, Wang, Linda, Crofts, Sara, Nixon, Thomas, Wu, Timothy, Chiesa, Roberto, Bose, Saideep, Turner, Jason, Moore, Ryan, Smith, Justin, Irshad, Ali, Hsu, Jeffrey, Czerny, Martin, Cullen, Jonathan, Kahlberg, Andrea, Setacci, Carlo, Joh, Jin Hyun, Senneville, Eric, Garrido, Pedro, Sarac, Timur P, Rizzo, Anthony, Go, Michael R, Björck, Martin, Gavali, Hamid, Wanhainen, Anders, D'Oria, Mario, Lepidi, Sandro, Mastrorilli, Davide, Veraldi, Gianfranco, Piazza, Michele, Squizzato, Francesco, Beck, Adam, St John, Rebecca, Wishy, Andrew, Humphries, Misty, Shah, Samir K, Back, Martin, Chung, Jayer, Lawrence, Peter F, Bath, Jonathan, and Smeds, Matthew R

Abstract

INTRODUCTION: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. METHODS: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. RESULTS: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3

Published
2021
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28. Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Author

Paraskevas, Kosmas I., primary, Mikhailidis, Dimitri P., additional, Baradaran, Hediyeh, additional, Davies, Alun H., additional, Eckstein, Hans-Henning, additional, Faggioli, Gianluca, additional, Fernandes, Jose Fernandes e, additional, Gupta, Ajay, additional, Jezovnik, Mateja K., additional, Kakkos, Stavros K., additional, Katsiki, Niki, additional, Kooi, M. Eline, additional, Lanza, Gaetano, additional, Liapis, Christos D., additional, Loftus, Ian M., additional, Millon, Antoine, additional, Nicolaides, Andrew N., additional, Poredos, Pavel, additional, Pini, Rodolfo, additional, Ricco, Jean-Baptiste, additional, Rundek, Tatjana, additional, Saba, Luca, additional, Spinelli, Francesco, additional, Stilo, Francesco, additional, Sultan, Sherif, additional, Zeebregts, Clark J., additional, and Chaturvedi, Seemant, additional

Published
2021
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29. Management of internal carotid artery near-occlusion: the need for updated evidence

Author

Antonopoulos, Constantine N., Giosdekos, Alexandros, Mylonas, Spyridon N., Liapis, Christos D., Antonopoulos, Constantine N., Giosdekos, Alexandros, Mylonas, Spyridon N., and Liapis, Christos D.

Abstract

Near occlusion of internal carotid artery (ICA) is a rare and easily misdiagnosed condition and the decision for revascularisation still remains controversial. We conducted an updated meta-analysis in order to investigate outcomes after carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment (BMT) in patients with near-occlusion of the ICA. We also aimed to investigate the role of time as a potential moderator of the near-ICA occlusion-stroke rate association. A multiple electronic health database search on articles published up to November 2019 was performed. The pooled stroke rate after CEA, CAS and BMT were calculated. We also investigated transient ischemic attack (TIA), stroke-related death, myocardial infarction (MI), any cause of death and ICA restenosis crude rates (%). A total of 33 articles were finally deemed eligible. The pooled stroke rate was 1.52% [95% confidence interval (CI): 0.09-4.02%] after CEA, 1.80% (95% CI: 0.61-3.40%) after CAS and 8.39% (95% CI: 3.39-14.80%) after BMT. Out of 896 CEA patients, we recorded 22 TIAs (2.5%), 33 all-cause deaths (3.7%), 5 stroke-related deaths (0.6%) and 6 MIs (0.7%). Concerning outcomes after 603 CAS patients, we recorded 7 TIAs (1.2%), 56 all-cause deaths (9.3%), 4 stroke-related deaths (0.7%) and 22 MIs (3.6%). Among 263 patients who were treated with BMT, we found 16 TIAs (6.1%), 10 all-cause deaths (3.8%), no stroke-related death, and no MI. Crude restenosis rate during follow-up was 9.0% (54/601) for CEA and 4.1% (24/592) for CAS patients. No significant effect of publication year upon stroke rate after CEA was recorded. However, there was a significant reversed association between pooled stroke rate after CAS and publication year (P=0.05). A statistically significant reversed association between pooled stroke rate after BMT and publication year was also recorded (P<0.01). The results of this updated meta-analysis revealed high stroke rate for patients with near-occlusion of IC

Published
2020

30. Carotid Artery Near Occlusion: Time to Rethink the Management?

Author

Zorgeenheid Vaatchirurgie Medisch, Brain, Circulatory Health, Regenerative Medicine and Stem Cells, de Borst, Gert J, Antonopoulos, Constantine N, Meershoek, Armelle J A, Liapis, Christos D, Zorgeenheid Vaatchirurgie Medisch, Brain, Circulatory Health, Regenerative Medicine and Stem Cells, de Borst, Gert J, Antonopoulos, Constantine N, Meershoek, Armelle J A, and Liapis, Christos D

Published
2020

36. Association between periodontal disease and vulnerable plaque morphology in patients undergoing carotid endarterectomy

Author

Bobetsis, Yiorgos A., primary, Kotsikoris, Ioannis, additional, Liapis, Christos D., additional, Liasis, Nikolaos, additional, Kakisis, John, additional, Kourlaba, Georgia, additional, Lazari, Paraskevi, additional, Antonopoulos, Constantine N., additional, Deliargyris, Efthymios N., additional, and Madianos, Phoebus N., additional

Published
2020
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